AHIMA TEAM TA... · 2014-04-21 · 2014 Implementation Timeline 6 . ... —Reduced reliance on...

AHIMA TEAM

Kathryn DeVault HIM Practice Excellence Senior Director

Bill Rudman Education & Foundation, Vice President

Who Is AHIMA

Not-for-profit association dedicated to HIM

Serves over 67,000 HIM professionals and 52 state organizations

Mission is to lead, educate, advocate for the HIM community

Affiliate Organizations: CAHIIM, CCHIIM and AHIMA Foundation

Objectives Define ICD-10 implementation timeline and

reasons for the transition

Identify individuals who should receive training

Evaluate training and education options available

ICD-10 implementation timeline

and reasons for the transition

• Final rule published in the Federal Register on September 5, 2012

• Mandatory Compliance date October 1, 2014

Implementation Timeline

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What are ICD-10-CM and ICD-10-PCS?

ICD-10-CM

• US clinical modification of the World Health Organization’s ICD-10

• Diagnostic coding system (no procedure codes)

ICD-10-PCS

• Developed under contract by CMS specifically to replace the ICD-9-CM procedural coding system

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ICD-10 CM/PCS Opportunities

• Quality measurement – Better data for evaluating and improving quality of care

• Reduction in complications and improved patient safety • Improved patient outcomes

– Improved ability to • measure outcomes, efficacy, and costs of new medical

technology • ascertain disease severity for risk and severity adjustment

• Improved Public Health – Enhanced public health surveillance – Better able to track and respond to global health

threats – Facilitate international comparisons of quality of care

and global sharing of best practices

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ICD-10 Opportunities

• Organizational Monitoring & Performance —Administrative efficiencies —Cost containment —More accurate trend and cost analysis —Improved ability to analyze trend and cost

data —More effective monitoring of resource and

service utilization —Reduced submission of medical record

documentation —Reduced reliance on manual medical review —Improved coding accuracy and productivity

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ICD-10 OPPORTUNITIES

• ICD-10-CM/PCS have the potential to decrease compliance risks –Lower coding error rate

–Fewer erroneous and rejected/denied claims

–Development of more sophisticated electronic tools to facilitate accurate coding

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ICD-10 O Opportunities

• Reimbursement – More accurate and fair reimbursement

– Better justification of medical necessity

– Fewer erroneous and rejected claims

– Increased sensitivity when making refinements in applications such as grouping and reimbursement methodologies

– Reduced opportunities for fraud and improved fraud detection capabilities

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ICD-10 Opportunities

• ICD-10-CM/PCS have the potential to decrease compliance risks –Reduced coding ambiguity and

misinterpretation • Increased specificity

• Improved logic

• Standardized, up-to-date terminology

• Combination codes

• Definitions for different types of Excludes notes

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Significant Improvement

• Enhanced system flexibility

• Better reflection of current medical terminology

• Expanded detail relevant to ambulatory and managed care encounters

• Incorporation of recommended revisions to ICD-9-CM that could not be accommodated

• HIPAA criteria for code set standards and NCVHS criteria for procedural coding system are met

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Individuals who should receive

training

Who Needs Training and Why?

• Coders

• Physicians and Mid-level Practitioners

• Other Healthcare Professionals

• Management and Executives

WHAT YOU NEED TO KNOW ABOUT ICD-10 CM/PCS TRAINING

Overview Courses

Assessments

Biomedical Foundational Courses

ICD-10-CM Coder Training

ICD-10-PCS Coder Training

Practice Exercises

Documentation Creators: by specialty

Evaluate Training and Education

Options

Training and Education Criteria

• Comprehensive – Covers all coders needs

– Access to supplemental materials (flashcards, etc)

– End of module tests

• Flexible – Private or public classes

– Online courses delivery

– Modularly built

– Access to a live person

• Proven – How long have they been offering training

– What is their expertise

• Access to ICD-10 courses

Determine Pricing

• Informal survey of online ICD-10 CM/PCS offering

– Training Packages Ranges

– Format of Training Ranges

• Difficult to compare “apples to apples”

• Found the Best Unit of Measurement is $/training hour or CEU hour

– Range from $20 – over $150 per hour

– Average was $36.00 per hour

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ICD-10 CM/PCS TRAINING SUGGESTED TRAINING PATHWAY

Questions and Answers

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Thank You

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